Application of free transverse gracilis myocutaneous flap for soft tissue defects of foot and ankle_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

Yemenlehan·Bahesutihan , FAN Chenchen , WANG Xin , Abulaiti·Abula , REN Peng ,  Aihemaitijiang·Yusufu

Department of Trauma and Microreconstructive Surgery, Orthopaedic Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China;

Corresponding author：

Aihemaitijiang·Yusufu, Email: ahmtjiang@163.com

Keywords：

Gracilis myocutaneous flap; transverse flap; foot and ankle; soft tissue defect; wound repair

DOI：

10.7507/1002-1892.202202065

Video：

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Objective To investigate the effectiveness of free transverse gracilis myocutaneous flap for soft tissue defects of foot and ankle. Methods Between January 2017 and December 2020, 16 cases (17 feet) of soft tissue defects of foot and ankle were repaired with free transverse gracilis myocutaneous flaps. There were 10 males and 6 females, with an average age of 38 years (range, 23-60 years). There were 9 cases of left foot, 6 cases of right foot, and 1 case of bilateral feet. The causes of soft tissue defect were traffic accident injury in 3 cases, heavy object smash injury in 4 cases, machine injury in 3 cases, infection in 4 cases, electrical burn in 1 case, and synovial sarcoma after operation in 1 case. The wounds located at the distal plantar in 2 cases (2 feet), the heel and ankle in 6 cases (6 feet), the dorsum of the foot in 7 cases (8 feet), and the first metatarsophalangeal joint to the medial malleolus in 1 case (1 foot). The size of wounds ranged from 6 cm×5 cm to 18 cm×7 cm. The size of flap ranged from 11 cm×6 cm to 21 cm×9 cm. The donor site was sutured directly. Results After operation, 1 case (1 foot) of flap vascular crisis, 1 case (1 foot) of partial necrosis of the flap, and 1 case of partial dehiscence of the incision at donor site occurred, all of which healed after symptomatic treatment. The other flaps survived, and the incisions at donor and recipient sites healed by first intention. All patients were followed up 12-36 months (mean, 24 months). Except for 1 case (1 foot) of swollen flap, which underwent two-stage trimming, the other flaps had good shape and texture. All the flaps had a protective feeling. At last follow-up, Kofoed scores of foot and ankle function ranged from 73 to 98 (mean, 89.7); 13 cases were excellent, 2 cases were good, and 1 case was poor, with an excellent and good rate of 93.8%. Linear scar was formed at the donor site without adverse effect on lower limb function. Conclusion The free transverse gracilis myocutaneous flap is an effective flap for repairing large soft tissue defects of foot and ankle due to its advantages of large excisable area, less variation of vascular anatomy, and concealment of donor site.

Citation： Yemenlehan·Bahesutihan, FAN Chenchen, WANG Xin, Abulaiti·Abula, REN Peng, Aihemaitijiang·Yusufu. Application of free transverse gracilis myocutaneous flap for soft tissue defects of foot and ankle. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(6): 766-769. doi: 10.7507/1002-1892.202202065 Copy

1.	王波, 杨良军, 常谦, 等. 游离股前外侧皮瓣修复小腿或足踝部软组织缺损疗效观察. 中国骨与关节损伤杂志, 2020, 35(6): 645-647.
2.	梁虹宇, 李养群, 杨喆, 等. 股薄肌在软组织修复重建中的应用. 中国美容整形外科杂志, 2019, 30(7): 416-418.
3.	Li P, Zhang H, Zhu J, et al. Foot and ankle reconstruction using the lateral supramalleolar flap versus the anterolateral thigh flap in the elderly: A comparative study. International Wound Journal, 2022. doi: 10.1111/iwj.13751.
4.	Pederson WC, Grome L. Microsurgical reconstruction of the lower extremity. Semin Plast Surg, 2019, 33(1): 54-58.
5.	Gohritz A, Osinga R, Haumer A, et al. Microsurgical reconstruction of the lower extremity in the elderly. Clin Plast Surg, 2021, 48(2): 331-340.
6.	阿尔肯·居曼, 买买艾力·玉山, 阿不来提·阿不拉, 等. 拱顶石皮瓣在修复下肢软组织缺损中的应用. 中国修复重建外科杂志, 2021, 35(8): 1038-1042.
7.	龙忠恒, 陈季玲, 徐培, 等. 拱顶石皮瓣修复臀部和下肢深度创面13例. 中华烧伤杂志, 2017, 33(3): 173-175.
8.	Yousif NJ, Matloub HS, Kolachalam R, et al. The transverse gracilis musculocutaneous flap. Ann Plast Surg, 1992, 29(6): 482-490.
9.	Wong C, Mojallal A, Bailey SH, et al. The extended transverse musculocutaneous gracilis flap: vascular anatomy and clinical implications. Ann Plast Surg, 2011, 67(2): 170-177.
10.	Kofoed H, Sørensen TS. Ankle arthroplasty for rheumatoid arthritis and osteoarthritis: prospective long-term study of cemented replacements. J Bone Joint Surg (Br), 1998, 80(2): 328-332.
11.	Estrella EP, Montales TD. Functioning free muscle transfer for the restoration of elbow flexion in brachial plexus injury patients. Injury, 2016, 47(11): 2525-2533.
12.	陈剑平, 杨建涛, 秦本刚, 等. 游离股薄肌移植重建臂丛损伤的早期并发症分析. 中华显微外科杂志, 2021, 44(2): 166-170.
13.	Armangil M, Ünsal SŞ, Yıldırım T, et al. Outcome of free gracilis muscle transfer for the restoration of elbow flexion in traumatic brachial plexus palsy. Jt Dis Relat Surg, 2021, 32(3): 633-641.
14.	Krakowczyk Ł, Opyrchał J, Bula D, et al. Dynamic reconstruction of the lower lip with free functioning gracilis muscle transfer. J Craniofac Surg, 2021. doi: 10.1097/SCS.0000000000008389.
15.	Fansa H, Schirmer S, Warnecke IC, et al. The transverse myocutaneous gracilis muscle flap: a fast and reliable method for breast reconstruction. Plast Reconstr Surg, 2008, 122(5): 1326-1333.
16.	张敬良. 努力追求创面修复的 “泳裤供区” 理念. 中华显微外科杂志, 2020, 43(1): 3-4.
17.	Park JE, Alkureishi LWT, Song DH. TUGs into VUGs and friendly BUGs: Transforming the gracilis territory into the best secondary breast reconstructive option. Plast Reconstr Surg, 2015, 136(3): 447-454.
18.	宋达疆, 李赞, 周晓, 等. 游离横行股薄肌肌皮瓣在乳房重建的应用. 中华整形外科杂志, 2019, 35(3): 237-242.
19.	Fattah A, Figus A, Mathur B, et al. The transverse myocutaneous gracilis flap: technical refinements. J Plast Reconstr Aesthet Surg, 2010, 63(2): 305-313.
20.	Gatherwright J, Knackstedt R, Kurlander D, et al. Anatomic location of a sensory nerve to the transverse upper gracilis (TUG) flap: A novel option for sensate autologous tissue reconstruction. J Plast Reconstr Aesthet Surg, 2019, 72(1): 137-171.
21.	Mahmood B, Marshall DC, Wolfe SW, et al. Cadaveric evaluation of myelinated nerve fiber count in the nerve to the gracilis muscle in relation to use as a free functional muscle transfer for elbow flexion. J Reconstr Microsurg, 2020, 36(5): 311-315.
22.	Hou Y, Yang J, Qin B, et al. Ultrasonic evaluation of muscle functional recovery following free functioning gracilis transfer, a preliminary study. Eur J Med Res, 2021, 26(1): 17. doi: 10.1186/s40001-020-00473-8.

1. 王波, 杨良军, 常谦, 等. 游离股前外侧皮瓣修复小腿或足踝部软组织缺损疗效观察. 中国骨与关节损伤杂志, 2020, 35(6): 645-647.
2. 梁虹宇, 李养群, 杨喆, 等. 股薄肌在软组织修复重建中的应用. 中国美容整形外科杂志, 2019, 30(7): 416-418.
3. Li P, Zhang H, Zhu J, et al. Foot and ankle reconstruction using the lateral supramalleolar flap versus the anterolateral thigh flap in the elderly: A comparative study. International Wound Journal, 2022. doi: 10.1111/iwj.13751.
4. Pederson WC, Grome L. Microsurgical reconstruction of the lower extremity. Semin Plast Surg, 2019, 33(1): 54-58.
5. Gohritz A, Osinga R, Haumer A, et al. Microsurgical reconstruction of the lower extremity in the elderly. Clin Plast Surg, 2021, 48(2): 331-340.
6. 阿尔肯·居曼, 买买艾力·玉山, 阿不来提·阿不拉, 等. 拱顶石皮瓣在修复下肢软组织缺损中的应用. 中国修复重建外科杂志, 2021, 35(8): 1038-1042.
7. 龙忠恒, 陈季玲, 徐培, 等. 拱顶石皮瓣修复臀部和下肢深度创面13例. 中华烧伤杂志, 2017, 33(3): 173-175.
8. Yousif NJ, Matloub HS, Kolachalam R, et al. The transverse gracilis musculocutaneous flap. Ann Plast Surg, 1992, 29(6): 482-490.
9. Wong C, Mojallal A, Bailey SH, et al. The extended transverse musculocutaneous gracilis flap: vascular anatomy and clinical implications. Ann Plast Surg, 2011, 67(2): 170-177.
10. Kofoed H, Sørensen TS. Ankle arthroplasty for rheumatoid arthritis and osteoarthritis: prospective long-term study of cemented replacements. J Bone Joint Surg (Br), 1998, 80(2): 328-332.
11. Estrella EP, Montales TD. Functioning free muscle transfer for the restoration of elbow flexion in brachial plexus injury patients. Injury, 2016, 47(11): 2525-2533.
12. 陈剑平, 杨建涛, 秦本刚, 等. 游离股薄肌移植重建臂丛损伤的早期并发症分析. 中华显微外科杂志, 2021, 44(2): 166-170.
13. Armangil M, Ünsal SŞ, Yıldırım T, et al. Outcome of free gracilis muscle transfer for the restoration of elbow flexion in traumatic brachial plexus palsy. Jt Dis Relat Surg, 2021, 32(3): 633-641.
14. Krakowczyk Ł, Opyrchał J, Bula D, et al. Dynamic reconstruction of the lower lip with free functioning gracilis muscle transfer. J Craniofac Surg, 2021. doi: 10.1097/SCS.0000000000008389.
15. Fansa H, Schirmer S, Warnecke IC, et al. The transverse myocutaneous gracilis muscle flap: a fast and reliable method for breast reconstruction. Plast Reconstr Surg, 2008, 122(5): 1326-1333.
16. 张敬良. 努力追求创面修复的 “泳裤供区” 理念. 中华显微外科杂志, 2020, 43(1): 3-4.
17. Park JE, Alkureishi LWT, Song DH. TUGs into VUGs and friendly BUGs: Transforming the gracilis territory into the best secondary breast reconstructive option. Plast Reconstr Surg, 2015, 136(3): 447-454.
18. 宋达疆, 李赞, 周晓, 等. 游离横行股薄肌肌皮瓣在乳房重建的应用. 中华整形外科杂志, 2019, 35(3): 237-242.
19. Fattah A, Figus A, Mathur B, et al. The transverse myocutaneous gracilis flap: technical refinements. J Plast Reconstr Aesthet Surg, 2010, 63(2): 305-313.
20. Gatherwright J, Knackstedt R, Kurlander D, et al. Anatomic location of a sensory nerve to the transverse upper gracilis (TUG) flap: A novel option for sensate autologous tissue reconstruction. J Plast Reconstr Aesthet Surg, 2019, 72(1): 137-171.
21. Mahmood B, Marshall DC, Wolfe SW, et al. Cadaveric evaluation of myelinated nerve fiber count in the nerve to the gracilis muscle in relation to use as a free functional muscle transfer for elbow flexion. J Reconstr Microsurg, 2020, 36(5): 311-315.
22. Hou Y, Yang J, Qin B, et al. Ultrasonic evaluation of muscle functional recovery following free functioning gracilis transfer, a preliminary study. Eur J Med Res, 2021, 26(1): 17. doi: 10.1186/s40001-020-00473-8.

Chinese Journal of Reparative and Reconstructive Surgery

Application of free transverse gracilis myocutaneous flap for soft tissue defects of foot and ankle

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